Suchergebnisse

Awareness of and responses to HIV health risks stemming from relations between sexual partners have been well documented in sub‐Saharan Africa, but few studies have estimated the effects of observed HIV status on marriage decisions and outcomes. We study marriage dissolution and remarriage in rural Malawi using longitudinal data with repeated HIV and marital status measurements. Results indicate that HIV‐positive individuals face greater risks of union dissolution (via both widowhood and divorce) and lower remarriage rates. Modeling studies suggest that the exclusion of HIV‐positive individuals from the marriage or partnership pools will reduce the spread of HIV.

AbstractAlthough the reproductive calendar is the primary tool for measuring contraceptive dynamics in low‐income settings, the reliability of calendar data has seldom been evaluated, primarily due to the lack of longitudinal panel data. In this research, we evaluated the reproductive calendar using data from the Performance Monitoring for Action Project. We used population‐based longitudinal data from nine settings in seven countries: Burkina Faso, Nigeria (Kano and Lagos States), Democratic Republic of Congo (Kinshasa and Kongo Central Provinces), Kenya, Uganda, Cote d'Ivoire, and India. To evaluate reliability, we compared the baseline cross‐sectional report of contraceptive use (overall and by contraceptive method), nonuse, or pregnancy with the retrospective reproductive calendar entry for the corresponding month, measured at follow‐up. We use multivariable regressions to identify characteristics associated with reliability or reporting. Overall, we find that the reliability of the calendar is in the "moderate/substantial" range for nearly all geographies and tests (Kappa statistics between 0.58 and 0.81). Measures of the complexity of the calendar (number of contraceptive use episodes, using the long‐acting method at baseline) are associated with reliability. We also find that women who were using contraception without their partners/husband's knowledge (i.e., covertly) were less likely to report reliably in several countries.

BACKGROUND: Male partner's approval is a key determinant of contraceptive use for women living in Sub-Saharan Africa and improving men's support and couple communication is a cornerstone of family planning programs. However, approval is often only measured through the women's perception of their partner's opinion. METHODS: This study conducted in Kinshasa compares contraceptive approval variables from matched male and female partners (n = 252 couples) to establish the frequency of (in)accurate perceptions by the woman, then test their association with modern contraceptive use. Additional regressions estimate individual and couple variables associated with (in)correct perceptions. RESULTS: Results confirm women are poorly aware of their partner's opinion but indicate that perceived approval or disapproval by the woman is a much stronger determinant of modern contraceptive use than her partner's actual opinion. Higher educational achievement from the woman is the strongest driver of misunderstanding her partner's approval. CONCLUSIONS: Women's perceptions of partner's approval are much stronger determinant of contraceptive use than the latter's actual opinion, and stereotyping men's opinion of family planning is a common error of appreciation. However, findings also suggest these misunderstandings might serve women's capacity to negotiate contraceptive use. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12978-021-01256-y.

AbstractContraceptive preferences are important for reproductive outcomes, such as contraceptive continuation and pregnancy. Current approaches to measuring reproductive preferences in population surveys are limited to exploring only fertility preferences and implicitly assume that contracepting people are using a method they want. We know that people change their fertility preferences over the life course as a response to life events, but there is no information about changes in contraceptive preferences, given the limited evidence about the measurement and distribution of contraceptive preferences. In this study, we examined the extent of change in women's contraceptive preferences over one year and identified characteristics associated with this change in Kenya using three rounds of nationally representative longitudinal data. Over one year, 18 percent of contraceptive users and 46 percent of contraceptive nonusers reported changes in their preferred contraceptive. Experiencing a pregnancy or birth and changes in marital status were associated with changes in contraceptive preferences for users and nonusers. We found that contraceptive preferences are dynamic, suggesting that family planning programs should ensure people's access to various methods to respond to women's changing circumstances and preferences.

Our objective is to illustrate how to create and maintain a healthy flow of carefully curated communication between a research team and a community of interest using the principles of cultural brokering. We begin with a brief critical review of the existing literature on cultural brokering between immigrant and academic communities. We follow this review with a case study of cultural brokering between a research team at Tulane University and the Vietnamese American immigrant community in New Orleans. We draw upon specific examples from an ongoing collaboration to illustrate types of cultural conflict that are common to academic and community collaborations, and we discuss how different types and features of cultural brokering have helped to resolve these conflicts and keep the project(s) moving forward. We summarize a set of traits, potential roles/contributions, and training and operating strategies for a cultural broker.

AbstractThe lack of validated, cross‐cultural measures for examining quality of contraceptive counseling compromises progress toward improved services. We tested the validity and reliability of the 10‐item Quality of Contraceptive Counseling scale (QCC‐10) and its association with continued protection from unintended pregnancy and person‐centered outcomes using longitudinal data from women aged 15–49 in Burkina Faso, Kenya, and Nigeria. Psychometric analysis showed moderate‐to‐strong reliability (alphas: 0.73–0.91) and high convergent validity with greatest service satisfaction. At follow‐up, QCC‐10 scores were not associated with continued pregnancy protection but were linked to contraceptive informational needs being met among Burkinabe and Kenyan women; the reverse was true in Kano. Higher QCC‐10 scores were also associated with care‐seeking among Kenyan women experiencing side effects. The QCC‐10 is a validated scale for assessing quality of contraceptive counseling across diverse contexts. Future work is needed to improve understanding of how the QCC‐10 relates to person‐centered measures of reproductive health.

OBJECTIVES: To what extent is DMPA-SC reaching new users versus encouraging method switching among existing users? Though increasingly-popular, little is known about characteristics of women using DMPA-SC in SSA. We compared characteristics of women using DMPA-SC with those of other modern methods, and identified the extent to which women using DMPA-SC switched from another method or are first-time users of contraception. STUDY DESIGN: We used data collected by the Performance Monitoring for Action (PMA) Project between 2016 and 2019 from three countries, Burkina Faso, Democratic Republic of Congo, and Uganda. We tabulated characteristics of DMPA-SC, DMPA-IM, implant, and male condom users, and used multivariate analysis to compare characteristics of women using DMPA-SC those of the other three methods. We also examined previous contraceptive method use (if any) among women currently using DMPA-SC. RESULTS: We found that never-married women were more likely to use male condoms instead of DMPA-SC. Women with two or more children (compared to no children or one child) were more likely to use implants instead of DMPA-SC in both Uganda and DRC. DMPA-SC was the first method used by the majority of current users in Burkina Faso and Uganda. DMPA-SC users who previously used another method generally switched from less effective methods. CONCLUSIONS: Although the characteristics of women using DMPA-SC varied across countries, DMPA-SC appears to be reaching new populations of women instead of inspiring existing modern users to switch to DMPA-SC, and appears to be appealing to first time users of contraception. IMPLICATIONS: It appears that DMPA-SC appeals to new contraceptive users in sub-Saharan Africa, which implies that DMPA-SC may have the potential to increase modern contraceptive prevalence in sub-Saharan African countries.

OBJECTIVES: Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is seen as a valuable innovation in family planning, but little is known about trends in DMPA-SC use or characteristics of users. Using data from Burkina Faso, the Democratic Republic of Congo (DRC) and Uganda, we measured trends in DMPA-SC and identified characteristics associated with DMPA-SC use. STUDY DESIGN: We used repeated cross-sectional representative data collected between 2016 and 2019. First, we plotted trends in DMPA-SC use for all women and married women. Next, we presented the sociodemographic and family-planning-related characteristics of DMPA-SC users. Finally, we conducted weighted multivariate logistic regression analysis to examine how DMPA-SC users were different from women (1) using all other modern methods combined and (2) not using any modern method. RESULTS: DMPA-SC use increased monotonically in all three countries. Many DMPA-SC users were first-time users of modern contraception (54.5% in Burkina Faso, 34.6% in DRC, 50.7% in Uganda). Never-married women had lower odds than married women of using DMPA-SC (compared to other modern methods) in all three countries [Burkina Faso adjusted odds ratio (AOR) 0.40, 95% confidence interval (95% CI) 0.20–0.80; DRC AOR 0.31 95% CI 0.10–0.93; Uganda AOR 0.24; 95% CI 0.08–0.71]. Level of education was positively associated with DMPA-SC use (compared to no use) (Burkina Faso AOR 1.79; 95% CI 1.03–3.14; Uganda AOR 3.23; 95% CI 1.33–7.84). CONCLUSIONS: DMPA-SC is a rapidly growing method in these settings. Despite the comparable levels of and increases in use for all three countries, the characteristics associated with DMPA-SC use generally differed across countries. IMPLICATIONS: This is the first analysis of patterns of DMPA-SC use with representative data for African countries. Our results confirm that DMPA-SC is increasingly popular, although the profile of users varies across settings.